Nipple Sparing Mastectomy with immediate reconstruction
Comments
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TN : OH!! Im so sorry you didn't get to your appointment. I know how I look forward to my appointments, each one feels like Im getting closer to the finish line...I keep thinking about spring and warm sunny days and tank tops with new foobs! Sounds like a long time from now but thoughts like that keep me going! I know what you mean about the spasms and holding off on working my arms. I'm afraid to do anything to trigger a problem, sometimes I just feel impatient: I used to work out every other day religiously and I haven't had any exercise since my BMx on Jan 11th!! I'll ask my PS tomorrow what the time line is in his opinion as far as exercise again. It will be interesting to see if the spasms are just as bad as ever or a little better this time....I lined up a friend to drive me just in case. Hope you get better weather ....:)
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Hi Ladies I've been off line for awhile as my MIL had passed away from complications of lung ca. When it rains it pours. My husband has had his hands full this year.
TN: Sorry you had to miss your appt. I know how I look forward to them and progressing to the next level. Good luck at yours Fairport.
My PS said there are no limitations, he said I could bench press. Well I'm doubting he knows what it feels like as I started with 3lbs and adv. to 5lbs for shoulder w/u and the next day am wiped out and sore.in the chest from the lift over the head and to the sides, I regretted thinking I am causing the muscle to tighten or shorten. I can use 5lbs for the bicep and tricep without difficulty. I find I just stare at the thought of lifting and am very afraid as the pain is still fresh. I am so fearful of even trying a plank. I asked he PS specifically if there is a risk of the implant falling out of place or off to the side under my arm and he said the pocket has healed and there is no risk of ruining anything.I am going to stick to the bicep and tricep adv as tolerated and keep at 3-5lbs for the shoulders with no chest work out for awhile longer.I am very concerned over weight shifting now that I started the arimidex.
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PB - sorry about your father in law. sucks.
- maybe get another opinion about the pecs. My PS was adamant when I asked him and he's not that conservative. My BS also said to be very careful.
I havent even tried to lift weights but I think I found a good PT and I go on Thursday for a consult. Ive been working on my range of motion independently and Im not as tight as I was last week. I feel the pull in my chest when I put my arms out to a T but I swear these TEs are way to big - Im going to be a lot smaller so not sure why they need this kind of stretching.
Im going stir crazy at home but I look forward to my daily dog walks - two to three miles a day. Its snowing so it should be a cold one today!
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PB and PSgood to hear from you. I am going to ask my PS when I go next Monday about working the pecs. I did hate rescheduling, but we live in the boondocks and when we get any type of winter weather our roads are very dangerous. Even if I wanted to, I don't know how much pec work I could do. I noticed when we were eating out yesterday that I still have a hard time pushing the condiment pumps down without my pecs doing some weird movement. I am excited about seeing my PS though, I have a hard little thing (almost like a very small pebble) sticking out on my BC side. It is very close to were I had my biopsy done, and maybe it is just me, but I have been wondering if it is the little piece of medle my GS put in when he did the biopsy, so he would know where to find the suspicious spot at a later time. I know it sounds weird since I had most of my breast tissue removed, but I'm not sure what else it could be. It is like a pin point about to poke through. I also am wondering what he is going to do about the BC breast not dropping. He had mentioned that I may have to wear a strap, not sure I like the sound of that, but it would be better than another surgery.
PB, I hate to hear about your mother-in-law, that does not help the stress level much! Weights are good to help keep the weight off, even though I have been walking, I still have put on and I think it is due to not being able to do my weight training. Working out is also a good stress relief for us. Keep up the good work!
PS, I have read other posts with woman who have the TE's and they say that the doctors always go larger than what your implants will be. I guess to make sure they have plenty of skin to work with. Your PS most likely will not want you dong anything with your pecs till after your exchange, you don't want those muscles tightened up.
Fairport, I can't wait for it to warm up! You made me smile with the mention of tank tops. I have already tried some on, just to see what they look like.
Let us know what your PS said.0 -
Hi Ladies
PB: so sorry about your MIL, what a lot of stress all at once.
TN: I cant figure out what the tiny mass is....at first I was thinking it is a little scar tissue, but by your description maybe it is the marker left behind? Now Im curious! Is it red or painful?
So I saw my PS yesterday morning, have had 28 hours of agonizing spasms which have now decreased significantly, as usual. His method is to fill 50% more than what I want then I can have the exchange surgery. Im not sure yet but I'm pretty close, I think I'm there now but will reassess next week ....at the most I'll have one more 40cc fill then call finished . I asked about exercise, he said free weights for biceps and triceps are fine now, also didnt seem to think there was any risk as far as pecs go but I hurt way too much to even think about it yet. I think I will readdress the whole exercise issue after my exchange.
I still hurt quite a bit this afternoon: even though the intense spasms have diminished there is still the steady pain. I think I will go try on some tank tops to cheer me up! Ha!
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TN:, I think you have a titanium marker in the subcutaneous tissue. During my biopsy the markers misfired. During the surgery they had to count how many they had and couldn't locate one more. It was in the subcutaneous and so that tissue had to come out as well as the breast tissue.
Fairport: I actually have no interest due to the pain to work on my pecs. I would love to do other exercises for the back and arms that don't involve the pec muscle and that is hard. I specifically asked my PS whether it was ok being in the future I will be exchanging out to a larger implant and do want any more tightening going on and he said it was ok to work it. My husband asked me why I kept bring it up and its because I'm doubting PS realizes how tight it felt and understood my concerns.
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PB I feel the same: I want to avoid ANY stress on my pecs...I am disappointed : the spasms came back last night and I was up half the night. Before all this, the reason I worked my pecs was to make my breasts less droopy: Silicone will take care of that now. I want to work triceps and biceps (at age 55 , my arms get pretty floppy if I slack off) but I cant imagine starting that yet, I'm wiped out! All upper body work will just have to wait. I have doubts PS understands ...he seemed surprised at the level of pain after fills that I described.
Im at 280cc in each: I think thats it for me.
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Fairport, I'm sorry you are having so much pain, but it sounds like you don't have much longer. What size are you hoping to be when you get your implants?
PB, I bet you are right about it being the marker. I have felt like that is what it is, but have not ever heard anyone mention it before. Did you have to have the marker removed after surgery or was it found during? I am not looking forward to what the doctor says about this. I am just hoping it has not damaged the implant. I have a spot close to the marker that has bubbled out. I'm pretty sure it is not scar tissue, because it is not hard, it is squishy. When I push on it, it pops back out. It is hard to explain, it is like a defect in a balloon when it bubbles out.
I hope all of our other ladies are doing well, we have not heard from you in a while. Well wishes to all!
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TN: When I had the stereotactic biopsy, the needle that is inserted by sort of robotics died while in me. After many attempts they finally were able to get suction for the biopsy. Markers were misfired as well. I was told they were not in the area of the biopsy. My BS knew going in how many markers to look for. He was one short. An xray had to be done and found one in the subcutaneous. I was told they often migrate as well over time, so its not uncommon. I am surprised they left one behind on you. It shouldn't be near the implant as its not in the breast tissue but close to the skin. For me it was an additional scraping and tissue removal, just what I needed. I learned this from reading my BS's surgical report. I had my recent PS visit and it looks like he doesn't want to see me again until I'm ready to exchange my implants for a larger size.
Fairport: I agree I see no reason to want to build up the chest for appearance as we are perky and most of our fat tissue is gone. I would like to work out the upper arms, delts, triceps. The back which would involve the chest muscle. I am having no problems with 3 and 5lb weights on the bicep and tricep except do notice a burn hours afterward in the area of the lymph node. Also the area behind the nipples are sore. I am noticing a weight redistribution to my belly since taking the arimidex. Great, now I have perky boobs and a belly. What week post op are you now.
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Good morning ladies,
I hope everyone is healing nicely! I cant believe a marker was left in you TN - hopefully this will be resolved soon.
Fairport - Im really sorry for the pains you are having. I hope that goes away soon for you.
I went to my first PT apt yesterday! Im six weeks post op and my range is not where it should be but she said Im catching up ok. She worked the soft tissue in my shoulder - OWW! that burned. She gave me some exercises to do at home too. Ill go twice a week for a few weeks to catch up and then once a week. I asked her about the pecs but she wouldnt give me a straight answer - kept saying it is the whole system to be worked. I also realized that maybe I had a different surgery than those that are allowed to work their pecs. I had the alloderm graft from a tissue donor.
Hope everyone is staying warm!
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Hi ladies
its the end of week 6 post op....had yet another difficult night....I am so NOT one to complain, but I share with you all as it keeps things in perspective and it helps to know your experiences. I originally thought I wanted to be a C cup when all is said and done. I tried on a couple of tops today and wow I certainly wont go any bigger than what the TEs are now! I think my small frame allows me to look bigger sooner.
PB nice to hear you can do some weights....Im going to give it a try! Before surgery I was using 15lb weights so I am thinking as of now I should be able to handle 5...
TN good luck with the marker....
PS nice to hear the PT is helping
I am returning to work on monday, that should be interesting! Luckily I only work part time!
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I am now 10 weeks post op. PS doesn't need to see me until I decide when I want to exchange out the implant to a larger one. I have graduated from PT. The therapist wanted me to get a new presciption for strength training, considering I haven't met my deductible and its out of pocket I will work on the strength training myself as tolerated.
PS73, my implants are held in my a graft mesh pocket. My PS assured me the implants were not moving anywhere and everything is healed and not going to rip. I am sore following day after the biceps and triceps behind the nipple.Not in a hurry. Think its all too soon for all of us to work the pecs.
Fairport: good luck at work on Mon.
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Hello all! I'm still working on a plan and still leaning heaving towards the BMX, even though the thought of losing my breasts is getting harder every day. I know many of you did the nipple-sparing surgery, but my doctor seemed like it wasn't even an option because there's too much breast tissue at the nipple. I get that, but it seems pretty common, at least I see it a lot on these boards.
Did anyone have trouble getting this surgery? Was it the idea of the BS or the PS? I have 2 appts this week with PS's and I'm hoping to get more info then. My BS also didn't seem like the immediate implant was much of an option. Again, a question for the PS, I know. Just wondering what your experiences were like with this.
Somehow, losing my breasts is a little mentally easier if I can keep the nipple. Maybe that won't matter to me at all once I have them. I know I won't feel normal, but if I can look "kinda" normal, I think it will help.
Thanks!
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Imnop, I understand were you are coming from on wanting to keep your nipples. It made my decision easier knowing that I was going to be able to have my own skin and nipples when the surgery was complete. Same outside, different inside. My general surgeon was the one to recommend the procedure and referred me to the plastic surgeon. If you are not satisfied with what your doctor is telling you, I would look at getting a second opinion, or search for a doctor in your area that does this type of procedure. We are here for you to answere any questions you have.
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Hello Ladies,
Well I had an interesting weekend. The weather turned for the good, in the 60's, so we decided to go for a ride on the bike to the mountains. We did the Dragon's Tail, which is 318 curves in 11 miles, and it was beautifu, no problemsl. Well, then we took off on the Cherohala Skyway, which was where we ran into a problem. The roads were clear until we got close to the top, rounded a curve, and hit an ice patch. We went down with the bike and slid on the ice about 15 feet. Fortunately, my husband was not going very fast. I landed on my boobs to beat all. We were able to get back on the bike, with some help, and headed home, wet and sore. I was very concerned that I had messed something up, but my PS said everything looked good today. The spot on my breast that we were concerned might be the marker, my PS says it's a patch of stitches not dissolved yet. He told me it was were he sewed in the Alloderm, which I never knew I had. I was surprised that he never mentioned this to me before. He is a great surgeon, but does not explain stuff very well. He also said that is why my breasts are still firm in the center, it is where the Alloderm has not softened up yet. I can lift up to 10 pounds now, and he says when I go back in 6 weeks, he will release me to do what I was doing before surgery. I have to wear a strap twice a day for 30 minutes to help lower my right boob. It was such a relief to get a good report after our little incident, I was a basket case before I saw my doctor.
Fairport, How was your first day back to work?
PB, Keep up the good work.
I hope everyone is doing well.
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Tn Lady and Imnop: I couldnt have said it better: the idea of same outside, different inside was just how I felt! And I have no regrets and my nipples are looking pretty good now, I think they are gonna be ok! At first they were black and necrotic looking but they are healing well now, week 7 post op.
PB thanks for your good luck wish about my returning to work! So today was the day, and I have to admit it was a couple of hours too long! It is funny how much you use your pecs without even knowing it: I even found pulling big doors open took a toll on me by the end of the day.I not in pain at qll tonite: just "feel"my pecs a lot, kind of a pulling feeling not a pain though..
tomorrow is my weekly fill at the PS so Im going to be in bad shape for a few days, but closer to the end!
Hope all is well with everyone
Imop: I really get what you are saying: I think the nipple sparing idea was what gave me the strength and confidence to go fwd and do this...good luck to you: I know its a hard decision....
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Imnop35:
The nipple sparing, skin sparing, immediate placement of implant is not mainstream yet. The surgeon has to be comfortable with the procedure and if he is stearing you away from it than he doesn't do it. Many surgeons are fearful of the cancer reoccuring in the tissue left behind. A frozen section behind the nipple will be taken and sent to path before they proceed with keeping the nipple. With the nipple and aereola remaining intact the surgeon will remove as much of the tissue behind it as he can.There will be some tissue left behind. My onc says cancer of the nipple is rare and she also recommending the procedure.
Ask your oncologist who in your area does this procedure. I had asked my onc which doctors had the best outcomes and cosmetic results. My onc is a woman and was honest.
My BS suggested it. He is the only one in my area that does it. He works with only a few of the PS. So if I had went to a PS not affliated at the same hospital, he would send me to who refers to him and I may not have known about the procedure. I have several friends, acquantances who have had bmx and this was not offered to them as they have had rads and chemo and were not candidates so its not out there and talked about. When I tell anyone what the procedure entailed , its the first time hearing about it. Also I think that since the onco type dx test came about showing a low score for reoccurance, it tends to help make the decision not to be more aggressive and take everything. Ten years ago everyone in our stage was getting chemo. BTW, my husband is a physician and had not known about this procedure until he was in the consult with me. We found this BS because he had a good reputation and my husband referred all his bc to him, but did not know the procedures that were out there. I was alittle surprised myself when I would ask my husband about the outcomes of his recon patients and he could only tell me they were happy with their surgeons but with the gown on during exam, he never checked out the handiwork, so he was not any help there.
It was a pleasant surprise and it did make it mentally easier and hopeful.
Where are you from? Perhaps you can make a thread asking who in your area does this procedure as there may be other woman who have come across it in their researching BSs.
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Imnop, I forgot to mention, they also have a procedure that is called skin sparing. You don't keep the nipple, but it allows you to keep your skin. Later on, they create a nipple for you. They even do nipple tattoos. I have read posts by woman that have had this procedure done on the exchange city thread. There is even a picture forum you could join to look at woman that have had similar procedures.0
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Hi ladies-
I had this procedure on Oct 9th in the Chicago area. I highly recommend my doctors - if anyone has questions, please let me know. I am now done with chemo and have a great result. I too am very athletic and some yoga stretches are hard. PT helps!! Rads start March 15th. Now if only I had my hair back.....best of luck ladies!!
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Hi girls, TN - stinks that you fell. Im glad things are ok though. This is exactly why I won't go skiing!! I have the time, the want and the SNOW but I dont want to risk it.
My range is 100% better! Ive been doing the excercises daily and I officially start the PT this Thursday as last week was quick excercises.
Imnop - you need to be a candidate for nipple sparing. It has something to do with the amount of breast and the placement of the nipples (if they are up higher vs drooping down). My BS had only done about five before but my PS had interned where it was done all the time. The reason my BS had not done many is because not many women are candidates for it. Maybe that will change in the future. You definitely want to go to someone excellent so its worth looking around if you fall into the nipple sparing category. And then get another opinion if you can because like said above, maybe they just aren't comfortable doing it. Its a 1% increased risk over traditional BMX.
Hope everyone is doing well. My dog attacks me everytime I do my excercises in the am - its kind of funny!
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jkwick, Welcome! Please keep us posted on your progress.
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TN: Glad you made it home safely from your outing with no injuries. Good thing the boobs are still numb. The PSs don'tt tell you much do they. I'm glad its only stiches. Mine were out as well at the incision line was rough to touch and he snipped them. Interesting with the strap. How long until you drop.
PS73: You'll improve fast with the PT.
JKWICK: Welcome, would love to have you share with us your experience with the procedure.Where you immediate implant or tissue expander?
IMNOP: My surgeon had done over 1000 of the nipple sparing. My PS said it is important for the BS to be able to do the procedure sparing as much skin as possible for the rebuild. He has to be experienced in knowing how much to tissue to scrape leaving the integrity of the skin.
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Hi,
I am waiting to meet with PS for Mastectomy with immediate reconstruction...I am nervous but can't wait to get started..What is to be expected? How long will I be down? I go to the gym 3-5 days a week.
Great Thread
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Chinup, You can expect a two to three day period where you don't feel like doing much of anything. You will be able to get up and walk around to take care of your basic needs, but that is about it. Most likely after the first week you will have your post-op appointment with your PS, that was the first time I got out after surgery. I was out of work for around 5 weeks, but during that time period I was getting out and doing things. I was allowed to walk for exercise two weeks after surgery, but no lifting. I am 9 weeks post-op and was just given permission to do weights for strength training. Every doctor is different on the exercise issue, you will have to check with yours to see what he recommends. I still remember how nervous I was before surgery, so whatever questions you have, big or small, please just ask and we will answer them as best as we can.
PB, He did not say how long it would take for the breast to drop. The strap is like a wide belt with Velcro that I wrap over the top of my breasts, which pushes my implants down. He also told me to keep massaging them. It is very uncomfortable , so I'm hoping the boob cooperates and drops quickly.
I hope everyone is having a wonderful week!
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Hi ladies. I haven't been around this thread too much lately because I'm preparing for 4 rounds of Taxotere and Cytoxan. My Oncotype DX came in at 25. I guess I could choose not to do chemo but my OC said if I do get a recurrence it would most likely be more aggressive and my overall chances for long term survival wouldn't be that good. I lost my dad to cancer that I believe came back as a distant recurrence 10 years after he had been "successfully" treated surgically for bladder cancer. I'd like to lower my odds of that. And if even 1 cell broke loose from that 1.1 cm IDC that was found in the pathology from my MX then I want to chase it down and kill it dead. Off course there are no guarantees, but this looks like the way to go. I'm so glad my BS brought my case up at tumor board because 11 Drs. agree that it is better to overtreat than undertreat. It makes my decision easier.
PS73, Is my thinking here consistent with what you know about chemo? I will also incorporate some naturopathic therapies as well.
My OC wants to wait until I'm healed from my MX before we proceed. Strangely enough, My PS says there is no reason to delay. Frankly, I don't mind waiting being as my still healing nipple could become an open door for infection when my white blood cell count goes down.
Well, finally I'm back on topic. I am 5 weeks post-op today. Nipple continues it's slow (at least to me) healing. I see PS once a week to check on it's progress and he clips bits of eschar as new tissue grows in underneath. I still clean the area with Hibiclens and apply Silvadene cream twice a day. Overall the nipple/areola has improved quite a bit in the last few weeks. I kind of wish I had taken pix earlier so I would have something to compare to. It just seems like it's taking forever. Maybe it's just that I'm getting tired of the wound care regimen.
TNLady, I'm so sorry you and your DH laid your bike down. I'm so glad you're both OK, tho. How's the bike? My DH says that HD actually stands for Hundreds of Dollars rather than Harley-Davidson because that's what it costs everytime you need to do anything to it. Still, on a beautiful day it's got to be worth every cent. I'm glad your recon survived too. On another note, I too had sutures work their way out thru the incision line and also in the area excised around my stereotactic biopsy scar. Some of them were pretty long and felt like whiskers growing. PS clipped them off or pulled them out. No problem since then.
I think that's all for now. The rain has stopped for the first time in days so I'm going to walk a couple of miles while I can. I'll check back in later. I hope everyone is having a good day.
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I also had a suture stick through my skin on the right breast, cleavage side. PS acted astounded as though he'd never seen such a thing. Clipped it off.
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carole: in this process makes me laugh how the PSs always seem surprised when we bring things up to them like we are their firsts.
Newbride: Thanks for checking back, was wondering how you made out. I would also go along with the chemo as well.
PS: Where were your incisions. I forget you are so new out and still dealing with the healing issues.
ChinUp: I was the other end of the pain scale as compared to TN. I was out of bed after three days. Took a good 4-5 weeks to be out of pain and off the pain medicine. 6 weeks was feeling like going out and being normal again, but the pain apprehension kept me in another week. At 8 weeks in PT and back to the gym. If you are working give it at least 6 weeks before returning and try to work it out where you go back part time or can leave early as you will be tired. You will have drains in 1-2 weeks and they are more bothersome than painful. Know that the drains will come out and don't rush it.
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Hi, my incisions are mixed. One is to the left of my aereola going at an angle twoard my armpit and the other is above my areola in a horizontal line (the original lumpectomy scar). Im six and a half weeks out.
NewBride, yes I think so. My onc didnt do an oncotype test because he was certain I needed to have chemo - the grade and my age were the factors since they believe the younger you are the more aggressive you can handle. He wanted me to do carboplatin and taxotere but I chose dose dense adria/cytox/taxol. Have you gone for a second opinion regarding the type of chemotherapy? I had four opinions and in the end I went with a johns hopkins rec but was treated at a different hospital. You can have control over what you do and also where you do it so don't ever think that just because you cant get to New York or wherever that you have to do the regimen recommended. My onc was perturbed with me but I really didn't care since I only saw him once a month. Just dont piss off the nurses! Anyway, being that you are her2nu negative I also think you are making the right choice about having chemo. Good luck with it. There is a thread about a shopping list for chemotherapy. Also, feel free to ask me anything regadless of how gross or weird or simple it is. The smallest things can make a huge difference in your comfort.
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NewBride, Nice to hear from you. Yes, it sounds like Chemo is the way to go and I think it's a good idea to wait until you are healed more. It does seem to take a long time for the nipples to heal, my nipple is still very red, but my PS assures me that it is okay. My DH's bike came out with minor damage. We have to replace a mirror and thats about it. But like your DH says, that will be a pretty penny. Actually, the mirrors are only around $40 bucks, but my husband wants to replace both of them and I'm sure he will find something else to buy while we are there. I might even find something to buy while we are there too, so yes HD sounds about right. He he! It sounds like you are healing well, I'm glad you checked in with us. Keep us posted on your treatment.
My suture has not come through the skin yet and I hope it dosen't! Yikes! It is like Carole's, not in my incision area, but at the top of my breast, close to where I had my biopsy. It seems to be softening, so maybe it is dissolving now. The strap is going well, although I can't tell any difference yet. I have only been using it a few days now. It is just a little uncomfortable, but luckily I only have to wear it for 30 minutes at a time. I have not tried the weights yet, just a little nervous. I will post how that works out for me when I get the nerve to try it.
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Hi TNLady. I had a bilateral nipple sparing mastectomy also on Nov 11th 2009. I had tissue expanders inserted at the same time. I'm scheduled March 29th to have the permanents put in. Everything has gone smoothly for me so far.The first 6 weeks were uncomfortable...sometimes a little painful but not nearly as bad as I thought it would be. My nipples have a few white spots on them and my boobs are too far apart but I was told this could be fixed. How is everything going for you?
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